CMS Price Transparency Data

Physical therapy (gait training)

Facility: Cleveland Clinic Martin North Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $156
Cash Discount Price: $172
vs. Medicare Baseline: 5.37x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Cleveland Clinic Martin North Hospital is $156. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $172. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 5.37x the Medicare baseline. Located in 200 Se Hospital Ave, Stuart, FL.

Cash / Self-Pay

$172

Average discount available for prompt cash payment at this facility.

Insurance Median

$156

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$29.06

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $29.06 (100%)

Cash / Self-Pay: $172 (592%)

Insurance Median: $156 (537%)

Cash: $172 (592% of Medicare)

Ins. Median: $156 (537% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $29.06 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 537% of the Medicare baseline (a markup of 437%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Aetna	$37 - $306	127%
Blue Cross Blue Shield	$37 - $593	127%
Humana	$37	127%
Miami Childrens Health Plan	$37	127%
United	$37 - $287	127%
Wellcare	$37	127%
Avmed	$39 - $100	134%
Careplus	$39	134%
Freedom Health	$39	134%
Multiplan	$39	134%
Clear Spring Health	$40	138%
Devoted Health	$41	141%
Cigna	$124 - $236	427%
Bmi	$145	499%
Clarity Health	$172	592%
The Legacy Companies	$172	592%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $172.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97116.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Cleveland Clinic Martin North Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97116.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.